School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India.
State Health Resource Center (SHRC), Raipur, Chhattisgarh, India.
Int J Rheum Dis. 2019 May;22(5):880-889. doi: 10.1111/1756-185X.13488. Epub 2019 Apr 4.
This study aims to measure current situation with regard to access and financial protection towards healthcare for rheumatic diseases (RDs) in India.
The first part of this study is quantitative, and uses the data generated by the 71st Round of National Sample Survey 2014, which measured self-reported morbidity, choice of provider and utilization of services and out of pocket expenditure (OOPE) incurred on healthcare services in a sample of 65 932 households and 333 104 individuals from all across India. The second qualitative part of the study was done in one sample district to understand the barriers to access and financial protection.
3.5% of all hospitalizations in the preceding one year and 9.9% of all ambulatory care in the preceding 15 days of this study period were due to RDs. Cost of care for RDs was three times higher in private sector. Cost on medicines comprised the largest share in both sectors. 54% of the households faced catastrophic health expenditure at 10% threshold (CHE-10) and this was nine times higher in private provisioning (OR: 8.8, CI: 6.8-11.4). 24% of the households had to borrow or sell household assets to meet the hospitalization expenditure. Insurance had marginal impact and it did not help in preventing household from facing CHE-10 for the lowermost three economic quintiles. There was significant unmet health care needs and lack of continuity of care of RDs in India.
Addressing the gaps in access and financial protection for patients with RDs need greater emphasis in policy as well as implementation, if the country has to achieve Universal Health Coverage.
本研究旨在衡量印度风湿性疾病（RDs）医疗保健的可及性和财务保护现状。
本研究的第一部分是定量的，使用了 2014 年第 71 轮全国抽样调查生成的数据，该调查衡量了全印度 65932 户家庭和 333104 名个体中自我报告的发病率、提供者选择以及服务的利用情况以及医疗服务的自付费用（OOPE）。研究的第二部分是在一个样本区进行的定性研究，以了解获得医疗服务和财务保护的障碍。
在过去一年中，所有住院治疗中有 3.5%，在本研究期间过去 15 天中所有门诊治疗中有 9.9%是由于 RDs 所致。RDs 的治疗费用在私营部门是三倍。在两个部门中，药品费用都占最大份额。54%的家庭在 10%的阈值（CHE-10）面临灾难性的医疗支出，而在私营部门这一比例高 9 倍（OR：8.8，CI：6.8-11.4）。24%的家庭不得不借款或出售家庭资产来支付住院费用。保险的影响不大，对于最低的三个经济五分位数，它并不能帮助家庭避免 CHE-10。印度存在着显著的未满足的医疗保健需求和 RDs 护理连续性的缺乏。
如果该国要实现全民健康覆盖，就需要在政策和实施方面更加重视解决 RD 患者在获得医疗服务和财务保护方面的差距。
